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Hurry Up and Die

In most countries, if an elected official told older adults to “hurry up and die” in order to save the state money on their medical care, it would border on political suicide. But in Japan, where people above age 60 comprise almost a quarter of the population, such a gaffe crosses the line of tone deafness and enters into the realm of the transcendently perverse. That’s part of the reason why Japan’s new finance minister (and deputy prime minister) Taro Aso, who uttered those very words to reporters on Monday, is already apologizing to anyone within earshot.

The fact that it happened in Japan matters, because all around the world, more and more people are living longer and longer, and Japan is at the forefront of this trend. With women living to age 87.4 and men to 80.6 on average, Japan is far and away the longest-lived country in the world, and has been for some time.

That’s why it’s so distressing to see a top Japanese official espousing antiquated ways of thinking about aging. Japan is leading us all into a greyer existence, and how it deals with the associated challenges and opportunities may presage how other countries fare. In the case of global aging, as Japan goes, so may go the world.

To lend some humanizing context to Aso’s quote, the finance minister was talking to reporters about his own end-of-life plans when he said he would prefer to die than rack up high medical bills in his waning days. “Heaven forbid if you are forced to live on when you want to die. I would wake up feeling increasingly bad knowing that [treatment] was all being paid for by the government," he said.

We all want to ‘square the quality-of-life curve,’ the euphemism for maintaining a high quality life right until death where we fall rapidly and die rather than experience a slow (and costly) slope of disease and disability in our later years. This should be defined as a challenge for science, engineering, business, public policy and individual health behaviors, not a target of blunt political rhetoric.

Giving credit where it’s due, end-of-life care is very expensive. In the US, for instance, it is estimated that one third of the medical expenditures incurred during the last year of life occur during the final month. But Aso’s word choice betrays an unfortunately intuitive and widely held misconception: the idea that aging is, in of itself, the problem. Since a problem is something that you solve, if you believe that aging is a problem, it’s all too easy to make the logical leap to the conclusion that older people should “hurry up and die.”

Aging is not a problem. Since when are birthdays – the gift of more than 30 years of longer life over the last century – a bad thing? However, given policy approaches and public thinking about aging (often locked in visions of what aging was 50 to 100 years ago) it’s far from unambiguously benign. Rather, global aging is a disruptive change that will affect all facets of life in complex ways – a shift that is already well underway in Japan. Like all great changes, aging equates to problems for some and opportunities for others.

When we consider aging not as a problem to be solved but a inevitable change we can work with, the question that arises is: how to maximize the public and private benefits of aging while minimizing and mitigating its ill effects. No single solution will easily translate what has been defined as a problem for centuries into an opportunity. We’ll have to realign our technologies, systems, and institutions in order to translate longer life into better living for all.

Which gets me back to Aso, who isn’t as completely thoughtless as he sounds. While elucidating his comments, he came out in favor of physical exercise, albeit in a decidedly grouchy way: "Why should I have to pay for people who just eat and drink and make no effort? I walk every day and do other things, but I'm paying more in taxes."

Since doing things like “walking every day” tends to help people live longer, presumably Aso acknowledges, deep down, that debilitating and expensive disease, not longevity, is the real issue that’s costing his country money.

Although grousing isn’t an effective way to lead people to take on healthier lifestyles, where crankiness fails, innovations in policy, technology and yes, even peer pressure, can lead to improved societal well-being, health behaviors and outcomes and ultimately reduced healthcare costs.

In addition to the promotion of healthy behaviors and technology-enabled services that contribute to wellbeing, I’ve discussed in this space other changes society can, will, or must make as it ages, and I will continue to do so (rethinking retirement, transportation, housing, etc.). As we contemplate these adaptations, it’s important to remind ourselves that aging is not a problem to be solved but a dividend of science, engineering, public policy and Providence to be cashed and invested. If we hope to benefit at all from the fruits of longevity, we have to recognize that old age is not a problem but old ways of thinking about it are.